Medical Anthropology: Uterus Transplantation for Women is the Future

The Emergence of Uterus Transplants in ART

Uterus transplants for women with MRKH

You may have never heard of a uterus transplant, but the procedure is one of the latest and most controversial breakthroughs in Assisted Reproductive Technology, also known as ART. A uterus transplant is a surgery for women that is currently only carried out in medical research programs.  The surgery involves taking a uterus from a living or deceased donor and transplanting it into a female recipient. Often, the recipient of the uterus is either someone who has had a hysterectomy, which is where the uterus is no longer present. Or, they have a rare condition in which they are born without a uterus. Referred to as absolute uterine fertility or UFI, this is more common than you might imagine. 

Women who are born without a uterus are diagnosed with a syndrome called Mayer-Rokitansky-Küster-Hauser (MRKH). MRKH will affect 1 in every 5000 women globally. Women with this syndrome will often still have ovaries but the uterus itself never develops. For a long time, if a woman was born with this condition, they had to accept that traditional pathways to parenthood would not include them. Now, uterus transplants that will allow these women to carry their children to term are slowly becoming a wild new reality. Reproductive rights are essential to everyone’s quality of life in society. If uterus transplants become a reality, many more cis-gender and potentially transgender women will have more options available for them. In the long run, this will also affect how we think as a society about reproduction and family.

The First Uterus Transplant In ART History

Lolita Wasterlund has a uterus transplant
Lolita Westerlund with her sister and healthy son. Credit:

The first human recipient of a uterus transplant was in 2002, making uterus transplants and parenthood a reality for women through ART. A woman in Dubai who had had a hysterectomy underwent an operation to receive a uterus. However, the process was unfortunately unsuccessful due to complications. The first successful uterus transplant took place in 2014 in Sweden, where two women received a uterus donated by their mothers and carried successful pregnancies to term. Since then, 50 uterus transplants have occurred globally, and 16 live births have occurred. For some, being able to experience this avenue to parenthood is an essential rite of passage that would be impossible without the use of reproductive technology. 

As mentioned earlier, often women receiving uterus transplants are born without a uterus, like Lolita Westerlund. She is one of the pioneering success stories of a uterus transplant, having used her sister’s uterus to give birth to her healthy son in 2015 successfully. Lolita and her sister went into surgery and exchanged a uterus by the time they were out. In a matter of years, she went from living her entire life without a uterus to carrying a successful pregnancy to term. She had always believed that becoming a parent in this way would be an impossibility for her. However, Lolita is just a ‘normal mum. When women have uterus transplants,  carrying their pregnancies to term goes from a sci-fi idea to actual medical reality in a matter of a few years. Although that may seem like a long process, it is well worth it for women like Lolita.

How Uterus Transplants Work

The uterus
Credit: The Conversation

Although there is positive progress for uterus transplants in the ART world, it is still a complicated process. As this is still an experimental surgery, a uterus transplant is only available in research programs. The process for qualifying for a uterus transplant is a tricky one for women who apply. Firstly, it requires that the women undergo medical examinations and fertility testing before the operation, knowing the recipient is healthy and can become pregnant. They will then undergo an IVF process. IVF is where doctors extract an egg from the recipient and artificially inseminate it outside of the womb. This fertilized egg will be placed in the uterus after the transplant operation. Once doctors feel confident that a pregnancy could occur, the transplant will go ahead. Another crucial prerequisite is that the parents be in a stable relationship for a minimum of three years.

The transplant itself is a major surgery as it is technically an organ transplant. After surgery, the recipient will take autoimmune suppressant drugs so their body does not reject the organ. These drugs can have severe adverse effects on some people. But for many women, it is a risk they want to take. In addition, the uterus is taken out after pregnancy has occurred, so that women do not have to keep taking immunosuppressant drugs long-term. The process for uterus transplants is not easy for women. However, for many of these women, the option to carry their child to term is a significant life event they want to experience. 

Why Do Women Want Uterus Transplants?

Kinship means many different things globally

Unlike other organ transplants, uterus transplants for women are not life-saving surgery. Instead, they will improve their quality of life. Reproductive technology assists hetero and queer couples in their journey to parenthood. IVF allows both men and women to consider their options if they have infertility or are in a queer relationship. IVF also contributes to more progressive views about changing social norms for queer couples. The ability for people to nurture and care for children of their own is one of the components essential for people to create a sense of kinship. Family is both a personal and cultural value. Those who are infertile may feel excluded from certain rites of passage that mark life progression. Or, if parenthood is not the path they choose, medical options allow people to make that choice themselves.

Reproductive technologies are inclusive because they allow people to consider what they want in the first place instead of being automatically excluded. Uterus transplants, however, take this even further. Now, women who do not have a uterus can not only experience pregnancy and parenthood but menstruation. Things such as menstruation and fertility are often crucial to how some women experience their sense of gender and womanhood. Women born without a uterus often express feelings of displacement or feeling disconnected from specific life experiences growing up. It isn’t often that we consider menstruation in a positive light. But the desire for uterus transplants asks us to consider what motivates recipients to undergo such a major surgery.

The Future Potential For Transgender Women 

Uterus transplants can be  for transgender women

As uterus transplants are in their early development, they are being trialled exclusively for people assigned women at birth who have UFI. However, the potential for uterus transplants for transgender women is something the future may hold. A very recent study done by obstetrics and gynaecology researchers investigated transgender perceptions and motivations for uterus transplants. The study found 99% of the transgender women interviewed thought a uterus transplant would improve their quality of life. In addition, many or all of the women agreed that a transplant would help with gender and body dysphoria.

Gender or body dysphoria is a feeling of anxiety or distress that people feel when someone’s gender identity differs from their assigned gender at birth. Many transgender women in this study expressed that the bodily experiences that come with having a uterus would help them identify more with their sense of womanhood. The ability to menstruate and be pregnant is a predominantly feminine experience many transgender women would like to have. 

As reproductive rights are human rights, the logical push would be for uterus transplants to become available for all people. While a uterus transplant is medically more complicated for transgender women, they are not impossible obstacles. With time and further research, they could easily be made safe and available. It is possible that including transgender women might lead to religious or ethical objections from some people. Despite this, researchers are calling for more inclusivity in medical programs. However, there were moral objections among the religious community regarding IVF, and it seems over time that it has become widely accepted and even welcomed.

Uterus Transplants One Step Further to Queer Kinship

Queer Family matters

Uterus transplants for women is a positive move towards changing family dynamics and being more open and inclusive. In anthropology and gender studies, this is often called queer kinship. In anthropology generally, kinship is a network of social relations that is found in most societies. It is how a community will categorize or express its systems of relationships. While this can look very different in many different cultures, it will usually relate to a system that you or I might understand as ‘family’ or simply a sense of belonging to a group. For a long time, the default model for this was heterosexual relationships, a nuclear family, and maybe a dog. Queer people often felt excluded from this family model or like they did not quite fit in. 

The term ‘queer kinship’ describes the many alternative ways that queer people create families and groups. In this way, they can develop a network of relationships that suits their own needs and desires. So, while IVF and adoption have helped expand alternative family arrangements in queer kinships, uterus transplants could extend this even more. For example, uterus transplants for transgender women would allow them to experience life in the body they truly want. Not only could they experience menstruation, but also the experience of being pregnant. For many people, even within queer kinships, being biologically related to your family has vast symbolic meaning. Transgender women can then share genetic ties with their children. Moreover, pregnancy for some allows for a bonding experience with their child.

Uterus Transplants Are Significant to Kinship Studies in Anthropology.

A traditional kinship graph

There are many different fields of anthropology. However, kinship studies are essential for cultural anthropologists. How a community categorizes and defines its relationships reflects how society and culture are structured. Anthropologists study how cultural values change and the reasons why that might be. Kinship structures reflect what a culture thinks of as taboo or accepted. It also reflects what obligations people in a society feel towards one another and shared beliefs. Therefore, it is essential to study human behavior. However, human behavior is variable. Reproductive technology has dramatically accelerated changes in society and relationships. For this reason, ART has been a considerable focus for anthropologists since the development of IVF. The last 40 years have seen substantial cultural shifts in what is considered normal or accepted in family-making. 

Uterus transplants for both cisgender and transgender women would allow for even broader definitions of family and gender. As Uterus transplants are a very new field of study, they are not a reality yet for many people. However, seeing new reproductive technologies emerge gives people a renewed sense of hope for the future. Having reproductive freedom allows for a sense of agency and autonomy for individuals. It is also a sign that cultural values are shifting, and this can be due to many different influences. Religion, politics, secularism, art, and literature all contribute to changing values. As this implements the structures of society, anthropologists will document new kinship terms. 

Cultural Significance in Anthropology

uterus artwork

As mentioned earlier, there are many ways of defining kinship. In the typical American and European societal structure, kinship is genetics, blood, and genealogical ties. Often, a family model will be based on the idea of a shared bloodline. If someone does not have a relationship with one or both of their parents growing up, they may still think of them as their blood family.

Classical anthropologists like Claude Levi-Strauss, who had a huge influence on kinship studies, thought kinship was a cultural expression of this biological tie. However, later anthropologists such as David Schneider critiqued this idea of kinship, saying it was Euro-centric. Many different cultures around the world do not define their kin structure by shared genetics. Their relationships are characterized by shared food, land, or the care-taking of children. In other societies, people share a kinship with plants and animals. 

Janet Carsten later noted that kinship can be broadly defined as sharing ‘substance.’ The term substance could mean different things in different cultures. For example, in our culture, a substance may be DNA. In another culture, such as the Kamea in Papua New Guinea, a substance may be sharing resources between different people. The comparative study of culture and family is crucial as it reminds us that values and beliefs are not universal. If we can increase our understanding of others, we become more open to change and societal variation. Uterus transplants may be met with resistance at first. However, they do not completely change how people define kinship; it only adds a layer of variation. 


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